Provider Demographics
NPI:1639819576
Name:SMITH, JENNIFER E (LMSW)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:E
Last Name:SMITH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:E
Other - Last Name:ORMISTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:47 PORCUPINE CIR
Mailing Address - Street 2:
Mailing Address - City:BALLSTON SPA
Mailing Address - State:NY
Mailing Address - Zip Code:12020-2348
Mailing Address - Country:US
Mailing Address - Phone:518-775-0439
Mailing Address - Fax:
Practice Address - Street 1:47 PORCUPINE CIR
Practice Address - Street 2:
Practice Address - City:BALLSTON SPA
Practice Address - State:NY
Practice Address - Zip Code:12020-2348
Practice Address - Country:US
Practice Address - Phone:518-775-0439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-30
Last Update Date:2022-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112174104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker